::Example of what orientation handouts will look like::

Welcome to the DBT Program

Greetings, and welcome to the DBT Program. Many people who seek therapy with us have tried several other treatments that have not worked for them. The good news is that as a DBT client, you have reason to be hopeful! We have seen many people just like you – skeptical and apprehensive, or perhaps despairing and hopeless (“trying yet another treatment”) that have benefited greatly from our program.

On the other hand, while you may be more than ready to give DBT a try, concerns about the time and money it takes to complete such a comprehensive program, or people in your life who are discouraging of you taking on such an endeavor, may be holding you back. Your therapist at the DBT Program is here to help you explore and resolve these obstacles, so that you can have the best possible treatment outcome. Please feel free to talk with your therapist whenever you have questions or concerns about the treatment or your progress with the program.

We know from experience that clients who are willing and put effort into their treatment make the greatest progress toward their goals. Here are some comments from past clients who have successfully completed the Program:

“Have an open mind and be open to new ways of thinking. It works!”

“Just stick with it; it will get better”

“I’ve tried so many types of therapies and therapists that haven’t made much difference. With the help of the therapist, I put DBT to work in my life and things are beginning to change.”

“This program is worth six months of your life.”

“If you don’t use it, it doesn’t work, but it you do, you’ll see the results.”

“I still struggles with my moods and relationships, but for the first time in my life, thanks to DBT, I am doing much better, and at times, even feel a little happy!”


In closing – our mission at the DBT Program is to provide research-supported treatments, such as Dialectical Behavior Therapy, to reduce suffering and enhance the quality of life for our clients and their loved ones. In collaborative manner, we will do our best to help you help yourself achieve your therapy and life goals.

::
ORIENTATION HANDOUT 1 ::
GROUP RULES AND FORMAT


Rules:
1. Clients who miss four consecutive scheduled sessions (individual or group), are considered out of therapy. Clients can apply to reenter the program at the time they were originally scheduled to complete their Phase 1 group (up to six months waiting period).

2. Each client has to be in individual therapy while participating in the skills training group

3. Missed sessions are charged to the client, not the insurance. Where 24-hour notice is given, the charge for a missed group session is $20.00. No-show or late-cancelled sessions are charged at the full rate, regardless of the reason missed.

4. Clients are not to come to group under the influence of alcohol or drugs.

5. Although it is okay for you to discuss what you are learning in group with others, do not discuss what other members say, or their names, outside of group.

6. The group starts promptly at the time schedules. Clients who are going to be late or miss a session should call ahead of time.

7. Please be respectful to others. Keep in mind that the group is composed of people of varying backgrounds-each person with their own set of opinions, values, and beliefs. Swearing in the group is prohibited, as are any derogatory racial, religious, sexual, etc. comments.

8. Clients may not form private relationships outside of training sessions and sexual partners may not be in skills training group together.

9. In group, the generic term “target behavior” is used to describe any and all problematic behaviors you have targeted for change in this program

10. Clients are not to discuss past (even immediate past) parasuicidal (self-harm) behaviors with other clients outside of session.

11. Come to group prepared. Bring your folder to group. It is also important to do your homework. In order for these skills to work, you will need to practice, practice, practice!

Group format:
1. Mindfulness practice
2. A brief check-in around how you are doing that day/week, followed by a report on homework: special assignments, reading discussion, how skills were used over the past week.
3. Unit material covered to date is reviewed
4. New information is presented
5. If scheduled, group practice exercises are done.
6. A closing check-out. Each client makes an “observing comment” based on their experience in the day’s/evening’s group.

::
ORIENTATION HANDOUT 2 ::
BORDERLINE PERSONALITY DISORDER (BPD)
DESCRIPTION OF PROBLEM AREAS


Emotion dysregulation: Individuals with BPD generally experience emotion dysregulation. They tend to be emotionally sensitive, quick to react with intense emotions and may demonstrate a slow return to their normal mood. They may have chronic problems with depression and anxiety, as well as with anger or anger expression.

Behavior dysregulation: Individuals with BPD demonstrate patterns of behavioral dysregulation, as evidenced by extreme and problematic impulsive behaviors. Attempts to harm themselves including recurrent suicide threats or attempts and self-injurous behaviors are common. Binge eating, drinking or drug use may also be a problem, as may episodes of promiscuity and gambling or spending sprees.

Interpersonal Dysregulation:
Individuals with Borderline Personality Disorder often experience interpersonal dysregulation. Their relationships may be chaotic, intense, and marked with difficulties. Despite these problems, they often find it extremely hard to let go of relationships and instead may engage in frantic efforts to keep significant others from leaving them. Their general experience is one of heightened interpersonal sensitivity, often accompanied by underlying fears of disapproval, rejection, and abandonment.

Cognitive Dysregulation: Individuals with Borderline Personality Disorder are at times, cognitively dysregulated. Brief episodes of “detached” thinking ranging from mild trance-like states to complete dissociation tend to be brought on by stressful situations and usually clears up when the stress is lessened. Extreme, black and white thinking is common, as is thinking permeated by self-doubt and indecision. Recurrent thoughts and images related to self-harm, often accompanied by overly critical and demeaning self-talk may also be present.

Self Dysregulation:
Dysregulation of the self is common for individuals with Borderline Personality Disorder. It is not unusual for them to say that they have no sense of self, feel empty, and do not know who they are or what they want. They may have difficulty expressing their needs, feelings, likes and dislikes to others and be easily influenced by the opinions and actions of those around them. They tend to be very concerned with outward appearances and frequently compare themselves and their situation to others’.

::ORIENTATION HANDOUT 3::
DBT BIOSOCIAL THEORY OF BPD

Emotional Dysregulation + Invalidating Environment = BPD

                         ::Characteristics of Emotion Dysregulation::
High Emotion Vulnerability:
1. Heightened sensitivity
2. Heightened reactivity
3. Slow return to normal mood

Low Emotion Modulation:
1. Difficulty changing physiological arousal associated with emotion
2. Difficulty attending and concentrating when emotional
3. Difficulty inhibiting mood-dependent action
4. Difficulty in working toward non-mood dependent goals

                    
    ::Invalidating Environment::
Characteristics:
1. Indiscriminately rejects or ignores communications of private experiences.
2. Responds to emotional displays only when they are intense and escalated.
3. Over simplifies the ease with which problems can be solved and goals can be met (e.g. "just do it").

What the Invalidating Environment Teaches the Individual:

1. Self-invalidate and only trust the environment's reactions and instructions on how to think, feel, and behave.
2. Go back and forth between stuffing emotions and expressing emotions intensly.
3. Form unrealistic goals and expectations (e.g. "I can't do anything," "I can do everything.").

::
ORIENTATION HANDOUT 4::
GOALS OF DBT SKILLS GROUP

General goal:

To learn and refine skills in changing behavior, feeling, and thinking patterns associated with problems in living.

::ORIENTATION HOMEWORK::
GETTING READY


1. Write down things you would like to change about your:
Thinking
Emotions
Behavior
Relationships

2. What's good about changing?        What's good about staying the same?
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